244 - The Relationship Between Coronary Sinus Diameter and Severity of Pulmonary Hypertension in Preterm Infants

Poster Number: 244
Publication Number: 244.222

Errica Capossela, Cohen Children's Medical Center, Astoria, NY, United States; Robert Koppel, Division of Neonatal-Perinatal Medicine, Cohen Children’s Medical Center, Northwell Health and Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, United States; Denise A. Hayes, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, United States; Allison Siegel, Division of Neonatal-Perinatal Medicine, Cohen Children’s Medical Center, Northwell Health and Feinstein Institute for Medical Research/Northwell, Boca Raton, FL, United States; irina gershkovich, Cohen Children's Medical Center, Hewlett, NY, United States

Background: Pulmonary hypertension (PH) is associated with increased morbidity and mortality in preterm infants. Screening typically includes B-type natriuretic peptide (BNP) measurement and echo. In adults, increased coronary sinus diameter (CSD) has been shown to correlate with elevated right atrial and pulmonary artery (PA) systolic pressures and severity of PH. There are no published studies examining the relationship between CSD and PH in neonates.

Objective: To investigate if a relationship exists between CSD and PH in neonates.

Design/Methods: This was a single center, retrospective chart review of 38 infants < 30 weeks with PH on echo defined by PA pressure >1/3 systemic BP. Infants were excluded if they had congenital heart disease other than small ASD/VSD/PDA or bicuspid aortic valve. Coronary sinus (CS) dimensions examined included CSD at the os and mid-portion (MP) with body surface area (BSA) correction. Echo indices included degree of PH (none/mild vs mod/severe), tricuspid regurgitation (trivial/mild vs mod/severe), right ventricular function (normal vs mildly/moderately/severely decreased), and presence of a PDA (yes/no). Statistical analyses included Spearman correlation and exact Wilcoxon rank sum tests to look for associations between each CS dimension and degree of PH and PDA presence. P-value < 0.05 was considered statistically significant. Records from 34 subjects were included in all final analyses.

Results: No statistically significant association was observed between os or MP CSD and degree of PH or PDA presence. However, there was a positive trend observed as babies with mod/severe PH had higher os CSD (2.70-3.50 mm lower/upper quartiles) compared to those with mild PH (2.30-3.05mm lower/upper quartiles). Similarly, MP CSD was higher in babies with mod/severe PH (2.50-3.10, lower/upper quartiles) compared to babies with mild PH (2.30-3.0, lower/upper quartiles). No statistically significant association was observed between os or MP CSD and other echo indices. Interestingly, BNP was significantly negatively correlated with os CSD (rs=-0.41, p=0.015) but not with MP CSD (rs=-0.34, p=0.015).Conclusion(s): We observed larger os and MP CSD in babies with mod/severe PH compared to those with mild PH. It is likely that the small sample size may have resulted in reduced power to detect statistically significant associations. The reason for the negative correlation between CSD and BNP is unclear. We speculate that CS enlargement may reflect increased intracardiac metabolism of BNP prior to secretion. Future studies may demonstrate utility of CSD as an additional marker for PH severity in neonates.